November 1, 2007

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In the Literature

Providing care in a patient-centered fashion—by making services available when needed, treating patients with dignity and respect, and allowing patients to share in decision-making—may seem at first blush to be inefficient and costly. But according to The Commonwealth Fund's Stephen C. Schoenbaum, M.D., M.P.H., designing clinical operations from the perspective of patient needs can actually mean less complex, less costly care.

In the article, "Can Care Be Patient-Centered and Clinically Efficient?" (Bulletin of the Royal College of Pathologists, July 2007), Schoenbaum, the Fund's executive vice president for programs and an expert in health care quality, explores ways that clinical laboratories can work toward this goal. Even though laboratories have only indirect contact with patients, he argues they can play an important role in promoting patient-centered care by making care simpler and more streamlined and by ensuring that patients receive timely, comprehensible information about clinical testing and test results.

In a 2005 Commonwealth Fund survey, 23 percent of U.S. adults who had a hospitalization, chronic condition, or emergency visit in the past two years said they experienced delays in receiving abnormal test results or were given incorrect test results. The same was true for 11 percent of patients in the U.K.

Schoenbaum suggests that laboratories should explore ways to reduce turnaround times for lab testing and reporting of results. Such changes could increase revenue or reduce use of staff resources; at the same time, they could improve care from the perspective of providers and patients.

Laboratories might also find ways to facilitate the communication of test results between providers and patients. One U.S. laboratory, for example, delivered copies of patients' test results with printed mailing labels to providers. Routine reporting of results skyrocketed, Schoenbaum says, while the volume of phone calls to the doctors' offices dropped—leaving office assistants more time for other functions.

Schoenbaum sets out three strategies through which laboratories can help to ensure efficient, patient-centered care:

Identify opportunities to eliminate unnecessary or inappropriate tests, such as by creating guidelines and training materials for clinicians.

Seek out sources of laboratory error re-lated to the collection, handling, and testing of specimens.

Facilitate follow-up after testing by reducing turnaround time and providing support to clinicians and patients. For example, laboratories could develop automated systems to remind physicians to respond to certain abnormal test results.

To pinpoint areas in need of improvement, laboratories should solicit feedback from their client base of providers and patients. To measure the impact of changes, they should evaluate the results in terms of client satisfaction and revenue. Avoiding unnecessary steps, streamlining work processes, improving coordination with physician practices—all hold the potential to improve the bottom line for laboratories.

There may also be opportunities for indirect savings, Schoenbaum says. "Laboratories should be able to make the argument that when they help the sequence of care become more efficient for the patient and the physician, they should share in the savings or at least recognize revenue from the savings to offset any additional expenses in the laboratory," he concludes.

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The mission of The Commonwealth Fund is to promote a high-performing health care system that achieves better access, improved quality, and greater efficiency, particularly for society's most vulnerable, including low-income people, the uninsured, minority Americans, young children, and elderly adults.